Association Between Rewarming Rate and Short-term Outcomes After Repair of DeBakey Type I Acute Aortic Dissection: A Propensity Score-matched Analysis

TL;DR

Faster rewarming during aortic dissection surgery may increase short-term death risk, according to a study using patient data.

Contribution

The study identifies a potential link between rewarming rate and postoperative mortality in aortic dissection surgery.

Findings

Faster bladder rewarming (≥0.5°C/min) was associated with higher short-term death risk.

Slower rewarming (≤0.2°C/min) did not show adverse effects on early outcomes.

No significant differences were found in other major postoperative outcomes.

Abstract

To evaluate the association between rewarming rate and short-term postoperative outcomes after repair of DeBakey type I acute aortic dissection (AAD).

From January 2019 to November 2023, 763 patients with DeBakey type I AAD undergoing total arch replacement (TAR) and the frozen elephant trunk (FET) procedure were enrolled. Patients were categorized into 3 groups according to bladder rewarming rate: high (≥0.5°C/min), medium (0.2-0.5°C/min), and low (≤0.2°C/min). Propensity score matching (PSM) was applied to balance baseline characteristics, and short-term postoperative outcomes were compared across groups.

After PSM, the incidence of short-term death differed significantly across the 3 bladder rewarming rate groups (overall P value = .021). Pairwise comparisons showed a higher incidence of short-term death in the ≥0.5°C/min group compared with the 0.2-0.5°C/min group (Holm-adjusted P value = .041), whereas no significant differences were observed between other pairs. No significant differences were found in other major short-term postoperative outcomes.

In patients with DeBakey type I AAD who undergo TAR and FET procedure, faster bladder rewarming (at ≥0.5°C/min) may increase the risk of short-term death, whereas slower rewarming (at ≤0.2°C/min) does not appear to adversely affect early postoperative outcomes. These findings should be interpreted with caution and underscore the need for further prospective investigation to define optimal rewarming strategies.

During aortic arch surgery, interruption of organ perfusion during cardiopulmonary bypass (CPB) can lead to ischaemic hypoxic injuries.

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